Anaemia as a consequence of malaria is one of the main causes for hospitalization among children in Malawi. As many die in hospital, many children also die at home, several months after hospitalization.

Robberstad is leading a five-year project, which is testing different follow-up methods for children under the age of five. Each follow-up method lasts for three months after hospitalization against malaria. The purpose is to find the best way to implement the most cost effective preventive action.

The children in the project have been so seriously attacked by malaria and anaemia that blood transfusions have been necessary. They have been treated with prophylactic medicine and sent home without any follow-up.

“These children are very weak and have a reduced immune system, which takes months to rebuild. That is reason why they need follow-up after hospitalization,” Robberstad explains.

May change national health priorities

As many as 300 children are recruited to the study that takes place in theZomba District Hospital area. The recruitment will be completed in May. All children have access to malaria medicine, but are split up into five groups with different follow-up procedures.

“If one of the follow-up actions becomes a success, it may lead to a new policy and a change in the health services in Malawi, one of the poorest countries in the world,” Robberstad points out.

The five treatment alternatives that are compared are:

Community-based: Mother given all PMC drugs at discharge without an SMS reminder.

Community-based: Mother given all PMC drugs at discharge with an SMS reminder.

Community-based: Mother given all PMC drugs at discharge with HSA reminder.

Facility-based: Mother asked to return to outpatient departments (OPD) for each monthly PMC without an SMS reminder.

Facility-based: Mother asked to return to outpatient departments (OPD) for each monthly PMC with an SMS reminder.

Limited health budget

According to Robberstad, as much as 60 per cent of the health budget in Malawi is financed by development aid from abroad. Some projects are supported by 90 per cent from other countries aid budget.

“The health budget in Malawi is limited, which means that the health politicians and donators have to make hard priorities. We can assist with health priorities,” says Bjarne Robberstad.

In addition to the project in Malawi, Robberstad has also started a clinical trial in Kenya and Uganda for measuring effects and safety using the malaria medicine (Cheomoproxylaxis). As many as 950 children participate in these studies. A total of 1150 patients are expected to participate within June 2018.

Facts

Malaria

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.

In 2016, there were an estimated 216 million cases of malaria in 91 countries, an increase of 5 million cases over 2015.

Malaria deaths reached 445 000 in 2016, a similar number (446 000) to 2015.

The WHO African Region carries a disproportionately high share of the global malaria burden. In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths.